Reason and treatment of failure of proximal femoral nail antirotation internal fixation for femoral intertrochanteric fractures of senile patients

Liu, J J; Shan, Lei; Deng, Bo-Yu; Wang, J G; Zhu, Wenjun; Cai, Zhengdong

doi:10.4238/2014.august.7.10

Cited by 20 publications

(16 citation statements)

References 18 publications

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“… 4 In contrast, Liu et al. 28 concluded that elderly patients with osteoporosis who underwent PFNA-II fixation achieved better outcomes in the initial 3 months. Eventually, however, there were parallel outcomes of functional recovery at the final follow-up.…”

Section: Discussionmentioning

confidence: 96%

INTERTAN nail versus proximal femoral nail antirotation-Asia for intertrochanteric femur fractures in elderly patients with primary osteoporosis

et al. 2017

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ObjectivesTo compare the long-term functional and radiographic outcomes of the proximal femoral nail antirotation-Asia (PFNA-II) and INTERTAN nail (IT) in the management of intertrochanteric femoral fractures (IFFs) (AO/OTA Type 31A1.1-A2.3) in elderly patients with primary osteoporosis.MethodsA retrospective comparative study was performed in our institution. From January 2009 to March 2012, 243 patients with osteoporosis (243 hips) with IFFs (AO/OTA Type 3.1A1.1-A2.3) underwent repair with either a PFNA-II or IT. Follow-up assessments were performed 1, 3, 6, 9, and 12 months postoperatively and every year thereafter. All implant position changes were noted. Patient-related functional outcomes were evaluated based on the Harris hip score.ResultsIn total, 174 patients with osteoporosis (IT, n = 86; PFNA-II, n = 88) were evaluated during a mean follow-up period of 40 months (range, 38–60 months). An increased risk of femoral shaft fracture after implant removal was observed at month 9 of follow-up in 0.0% and 4.4% of the IT and PFNA-II groups, respectively. This difference remained over time with rates of 1.1% and 6.8%, respectively, at the last follow-up.ConclusionThe IT nail appears to be a reliable implant in the management of IFFs (AO/OTA Type 3.1A1.1-A2.3) in elderly patients with primary osteoporosis.

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Section: Discussionmentioning

confidence: 96%

INTERTAN nail versus proximal femoral nail antirotation-Asia for intertrochanteric femur fractures in elderly patients with primary osteoporosis

et al. 2017

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“…With the rapid increase in the elderly population, the morbidity of intertrochanteric femoral fractures (IFFs) is also displaying a rising trend [ 1 – 3 ]. And IFFs account for approximately half the hip fractures in elderly patients [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation-Asia in the treatment of unstable intertrochanteric femur fractures in the elderly

Zhang

Zhu

et al. 2016

J Orthop Surg Res

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BackgroundThe purpose of this study was to compare the clinical outcomes of elderly patients undergoing surgery for treatment of unstable trochanteric fractures receiving either proximal femoral nails anti-rotation-Asia (PFNA-IIs) or InterTan nails (ITs).MethodsBetween January 1, 2012, and June 31, 2015, 168 elderly patients with unstable intertrochanteric femur fractures enrolled in this study. The only intervention was ITs or PFNA-IIs of the unstable trochanteric femur fractures. Follow-up was at 1, 3, 6, and 12 months postoperatively and yearly thereafter. Intraoperative variables and postoperative complications were compared between the two groups.ResultsEight patients died, six were too infirmed for follow-up, and seven were lost during follow-up, leaving 147 patients meeting the criteria were evaluated at a mean follow-up of 20 months (range 16–26 months). Significant differences were observed between the two groups regarding local complications (IT, n = 10 vs. PFNA-II, n = 20), varus collapse of the head/neck or femoral shaft fractures at the tip of the nail (IT, n = 1 vs. PFNA-II, n = 8), femoral neck shortening (IT, 4.4 ± 1.1 mm vs. PFNA-II, 7.4 ± 2.4 mm), fracture healing time (IT, 14.7 ± 2.1 weeks vs. PFNA-II, 15.7 ± 2.4 weeks), femoral shaft fractures (IT, n = 0 vs. PFNA-II, n = 4), rotational loss of reduction (IT, n = 0 vs. PFNA-II, n = 9), lateral cortex fractures of the proximal femur or lateral greater trochanter fractures (IT, n = 8 vs. PFNA-II, n = 1), operative time (IT, 71.9 ± 6.8 min vs. PFNA-II, 52.3 ± 4.0 min), intraoperative blood loss (IT, 190.6 ± 6.0 mL vs. PFNA-II, 180.9 ± 10.8 mL), fluoroscopy time (IT, 5.0 ± 0.48 min vs. PFNA-II, 2.8 ± 0.33 min), hospital stay (IT, 9.65 ± 0.95 days vs. PFNA-II, 8.58 ± 0.93 days), cut-out (IT, n = 0 vs. PFNA-II, n = 6), and tip-apex distance (IT, 26.7 ± 0.91 mm vs. PFNA-II, 23.2 ± 1.22 mm). No significant differences existed for the other observation indexes (p > 0.05).ConclusionsThe IT nail may have more advantage for patients with unstable intertrochanteric fractures of the femur. However, for those complicated with lateral greater trochanter fractures, lateral cortex fractures of the proximal femurs, or unfit for surgery, the PFNA-II nail could be a good option. In addition, a large-sample, multicenter observational study is required for evaluation of its long-term efficacy, and optimal management strategies for specific unstable fracture patterns, different sorts of bone quality, and different levels of patient demand.

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“…In India due to better health care life expectancy has increased which lead to high proportion of older population in society, because of that morbidity of hip fracture also in raising trends [1][2][3] .…”

Section: Introductionmentioning

confidence: 99%

Functional outcome of proximal femoral nail antirotation with helical blade fixation in extra capsular hip fractures in Himalayan region

Kushwaha¹,

Sharma²,

Dhingra³

et al. 2018

Int. J. Orthop. Sci.

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Background: Extra capsular Intertrochanteric hip fractures occur in older age person. These are pathological fracture mostly (osteoporosis). Currently, these hip fractures are generally fixed with intramedullary or extramedullary implants. Implants preference mainly determined by the fracture classification (stable or unstable). Most common complications in standard proximal femoral nail and extramedullary implants is neck screw cutout. Due to Research and improvement in surgical technique incidence of neck screw cutout has reduced considerably but still remains the most common fixation failure with intramedullary implants. With this question in mind we did study to find out functional outcome of proximal femoral nail antirotation with helical blade fixation in extra capsular hip fractures in Himalayan region. Methodology: This prospective study was done on 75 patients with extra capsular hip fractures, for fixation of fracture, implant of choice were used proximal femoral nail antirotation with helical blade. Study were done during the period from September 2015 to August 2016. Informed written consent were taken from all patients. The study was approved by institutional ethical committee. We included > 45 year cases. Fracture was classified according to Boyd and griffin classification. Exclusion criteria were age<45 years, open intertrochanteric hip fractures, pathological fracture other than osteoporosis and polytrauma patients. After discharged from hospital patients were called in OPD for clinical and radiological evaluation at regular intervals (6wks. 12wks, 24 wks, 36 wks. and 48 wks). Results: 75 cases of hip intertrochanteric fractures were included and operated with proximal femoral nail antirotation with helical plate. Mean age of patients was 65.67±10.60 yrs. (45-94 yrs.). Based on preoperative x-rays fracture pattern 8 cases in type1, 18 cases in type 2 and 3 in each group, 31 cases in type 4 were recorded. Assessment of osteoporosis were done according to Singh index. Type 1 (n=8), type 2 (n=18), type 3(n=18), type 4 (n=31) were had mean Singh's index 5.13, 4.59, 4.76, 4.70 respectively. Maximum number of patients (97.2%) showed sign of union between 18 to 24 weeks. The mean TAD was 24.69 mm±3.16 mm (Range 20-32mm). Union was achieved in all patients (n=66) at 48 weeks Harris Hip score was 38.47±13.14, 61.70+19.10, 83.44+12.24, 94.06+4.71, 98.18+4.27 and 98.68+1.84 respectively. At all the follow up intervals, Harris Hip score was improved (p<0.001). In our study overall outcome of patients (n=70) at 48 weeks who could complete the follow-up were good in 41 (58.5%), average in 25 (35.7%) and poor in 4 (5.7%) cases. Conclusion: Proximal femoral nail antirotation with helical blade gives better fixation even in osteoporotic intertrochanteric unstable femoral fractures. But preoperative assessment and planning, reduction and surgical technique should be followed. Intramedullary fixation has biological and biomechanical advantages over extra medullary fixation, helical blade has better bone hol...

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Reason and treatment of failure of proximal femoral nail antirotation internal fixation for femoral intertrochanteric fractures of senile patients

Cited by 20 publications

References 18 publications

INTERTAN nail versus proximal femoral nail antirotation-Asia for intertrochanteric femur fractures in elderly patients with primary osteoporosis

INTERTAN nail versus proximal femoral nail antirotation-Asia for intertrochanteric femur fractures in elderly patients with primary osteoporosis

A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation-Asia in the treatment of unstable intertrochanteric femur fractures in the elderly

Functional outcome of proximal femoral nail antirotation with helical blade fixation in extra capsular hip fractures in Himalayan region

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